Reimbursement Policy Update: Facility Charges for Office Evaluation and Management Services

Effective November 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a revision to the reimbursement policy Evaluation and Management (E&M) Services.

For office or clinic-based E&M services, facility claims with revenue codes 051x, 052x, and 076x will no longer be eligible for reimbursement. This change applies to all E&M services provided in an office or clinic setting. Previously, revenue code 0761 (treatment room) was not reimbursable for office or clinic-based E&M services. This policy will now encompass the additional revenue codes listed above. This change does not apply to non-E&M services billed with these revenue codes. Please see the related policy notification for more information. 

Blue Cross NC is making this change in alignment with our mission to make healthcare more affordable for all. We aim to improve our member experience by ensuring lower cost share and a single claim as opposed to two (2) separate (professional and facility) claims.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, State Health Plan and Federal Employee Program (FEP). This will not apply to IPP Home or Senior Market Administration (SMA).